Most religious communities have identifiable beliefs and values related to sex and sexual activity, especially as they involve young people. These beliefs are often associated with particular directives, often proscriptions that are intended to influence youth behavior. In fact, religious youth do have notably distinct attitudes and behaviors about sex. Among adolescents and young adults, religious beliefs and practices are associated with lower rates of ever having had sex, with later initiation of sexual activity, with frequency of sexual activity, and with fewer sex partners. Not surprisingly, religiosity is also associated with less permissive attitudes toward sex.
Religious persons also tend to hold less tolerant views about suicide than their nonreligious peers. Moreover, adolescents and adults with religious involvement are less likely to commit suicide, to attempt to commit suicide, and to think about suicide.
While substances, sex, and suicide have been at the center of most research about religion and adolescent health, some researchers have branched out to learn about religion's possible wider role. John Wallace and Tyrone Forman analyzed questionnaires from nearly 5,000 high school seniors from across the United States that asked about their religiosity and a wide range of their health-related behaviors.
In this questionnaire religion was measured in three ways: by religion's importance to the student's life, by their attendance at religious services, and by their affiliation with a religious denomination or tradition. The behavioral risk factors they studied included cigarette, alcohol, and marijuana use, diet, exercise, sleep patterns, and injury-related behaviors including carrying a gun, knife, or club, engaging in interpersonal violence, seat belt use, drinking while driving, and riding while drinking.
Their findings regarding religiosity and substance use echoed the inverse relationship found in other studies: the more religious the youth, the less likely they were to use drugs. In parallel fashion, greater religiosity was associated with less involvement in injury-related behaviors. Also the more religious youth were more likely to have "healthy" diet, exercise, and sleep behaviors. In sum, religious youth were less likely than their peers to behave in ways that risked their health and more likely to behave in ways that could improve their health.
MECHANISMS OF INTERACTION
A large dose of caution is needed in interpreting these research findings. The presence of an association between religion and health does not necessarily imply a cause-effect relationship. We know that adults who attend religious services regularly tend to live longer. This may seem to suggest that attending services causes a person to live longer but such clear cause-and-effect relationships have yet to be established.
Precisely how religion shapes health and disease is hard to say with any degree of certainty. Three main mechanisms or pathways of interaction between religion and health have been proposed. The first mechanism, suggested already, is that religion, through its teachings for instance, promotes or inhibits healthy behaviors. A strongly held belief or value, such as the body should be treated with respect, may encourage religious persons to avoid risky behaviors and to practice health-promoting behaviors. These healthy behaviors in turn improve health and well-being and thus reduce the likelihood of disease.
Another way that religion may affect physical health is through its effects on mental health. High levels of religiosity is associated not only with less suicide, but also with less depression, greater optimism, and better coping skills in response to stress. Stress is known to have significant effects on the body's immune system. To the extent that religion mediates the effects of stress through, for example, its coping benefits, this may be another pathway by which religion affects physical health.
The third proposed mechanism for religion's influence on health is through religion's provision of social support, an important factor in health. The often rich social networks available in religious communities are proposed to be protective of health in various ways: by mediating stress and improving coping abilities, by providing health screenings for disease prevention and early disease detection, and by helping ill persons deal physically, emotionally, and socially with their conditions.
To further complicate this already complex picture, each of these three mechanisms appears to interact with one another. Careful research is needed to clarify these relationships.
Research on the relationships between religion and health is a relatively new field of inquiry. Many studies to date have significant limitations because of design flaws. Some studies use small unrepresentative samples; others consist of secondary analysis, meaning that the studies were done for some other purpose and then the data were used to consider religion and health. Still other studies inappropriately generalize their narrow findings to a larger population.
One challenge facing all research in this area is the problem of adequately measuring human religiosity and/or spirituality. Different measures can lead to different results, producing questionable findings. How can we best measure a person's religiosity? Given the varieties of human religiosity beyond the largely Christian experiences currently being studied, what measures appropriately reflect human religiosity? Existing measures of religion are commonly distinguished by whether they represent public or private dimensions of religion. Public dimensions include measures such as whether a person is a member of a religious community, how frequently they attend religious services or religious youth groups, and how much time they spend in them. Examples of private dimensions include how important religion is to a person's life; whether a person holds specific beliefs, attitudes, or values (e.g., belief in the existence of God); and how often a person prays or meditates.
None of these measures alone captures the intricate nature of religion. This explains why some studies incorporate several dimensions into their measure of religion. The development of more sophisticated, multifactorial measures of religion is a high research design priority.
Modern Western medicine focuses primarily on identifying and treating diseases of the physical body. The psychological dimensions of disease and health have received significantly less attention, and the spiritual dimensions have received even less so. But at the turn of the 21st century this is changing, and medical interest in religion and spirituality is thriving in ways that warrant hope for a deeper and more inclusive interest over time.
Medicine's growing interest in spirituality is due in part to the religion and health research described above, which has contributed significantly to an increased understanding of the effects of religious/spiritual practices, beliefs, and feelings on health and healing. Two other factors have played important roles: a greater recognition and appreciation of the diversity of medical and cultural worldviews present in the United States and a rising patient demand for whole person care that includes spirituality.
Patients as a group, that is to say, the general population, are more religious than physicians as a group. This fact suggests that medicine must be intentional about its inclusion of the spiritual into physical health matters. As such, the Association of American Medical Colleges has established a set of learning objectives for medical students regarding spirituality. These objectives include being aware that spirituality is important to health and that spirituality ought to be incorporated into patient care as well as recognizing that medical students' spiritualities and cultural beliefs affect how they care for patients.